Irene jie (F/52) came for eye examination, with complaint of slight blurry near vision with existing glasses of 8-9years that she uses for driving & general use.. she finds this pair of specs to be comfortable. She has another separate pairs of single vision specs -3.75 both eyes, made few years ago but she finds it uncomfortable to wear. She wears contact lenses every day for dancing & outings.. but she cannot wear them for too long. After her dancing, she will remove contact lens.. only to wear them back before she goes out again later in the day. Sometimes, she does have headache.
Vision without glasses
R: 6/45
L: 6/45
Vision with existing glasses 8-9years
R: -3.75 (6/6-)
L: -3.75 (6/7.5-, 6/6-)
Add: +2.00
Examination shows: (Delay Fogging)
R: -3.75/-0.25×90 (6/6) [+1.00 blur lens test: 6/12] (R: right dominant eye) L>R
L: -3.75/-0.25×10 (6/6) [+1.00 blur lens test: 6/9]
Add: +2.25 (N5@40cm) R>L
She prefers without astigmatic correction in both eyes.
Adding +0.50 in left eye, R>L
Modified
R: -3.75
L: -3.75
Add: +2.25
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
NMD @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 1 EP (yellow part)
Near: 0 – 2 XP (blue part)
-1.00 Near: 0 – 2 XP (blue part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.75
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12/18cm 12/18cm, 13/19cm, 13/19cm, 14/20cm, 14/20cm
no doubling is reported (patient reported that vertical line moves to her left side at end of RAF rule)
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/10/8
Near, Base-In/Divergent, NFV: x/16/14
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: 16/14
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 6 cpm (double with Base Out, blink then can see single back)
Distance: 3 cpm (double with Base Out, blink3 then can see single back slowly)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
All near tests are done with Add.
Interpupillary distance, IPD = 5.8cm